Exclusive GPs are being billed inflated indemnity costs to extend their cover for seven-day working as they are based on out-of-hours premiums, the GPC has claimed.

The GPC said some GPs are being charged higher fees for covering the extra sessions because medical defence organisations were basing the costs on risk algorithms developed for urgent out-of-hours work – even though the work involved delivering predominantly routine, non-emergency care.

Medical defence organisations insisted they did not necessarily class the extra sessions as out-of-hours work, but consider fees on a case-by-case basis.

It comes as the GPC is beginning work on looking at indemnity fees and how they can be reduced for GPs. Pulse has previously reported that out-of-hours GPs have been quoted premiums of up to £30,000.

But the GPC has said that the medical defence organisations are lumping routine weekend working in with out-of-hours care when calculating risks in many instances.

Dr Dean Marshall, a lead negotiator for the GPC on contracts and regulation, told Pulse: ‘Because people are now say, doing Saturday morning surgeries in a network, the defence bodies don’t have any historical risk data so what they do is basically say that’s the same as out-of-hours. And it’s not – often you will be sitting seeing booked patients.’

The GPC is in talks with the defence bodies to try to resolve the issue, Dr Marshall said, but he warned GPs to be ‘absolutely clear’ in the meantime what the work they are doing involves before getting cover.

He said: ‘What we’ve been saying to the medical defence organisations is they need to look at the way they assess risk. We’re not criticising them, but we they need to be absolutely sure that their assessment of the risk is based on an understanding of what the GPs are actually doing.’

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The GPC is planning a symposium in mid-September, bringing together the medical defence bodies, NHS England and the NHS Litigation Authority, in an attempt to resolve some of the problems.

However, Dr Marshall warned the latest issues could ultimately make the Government’s plans for extending working hours unviable.

Dr Marshall said: ‘There is a fair amount of money being thrown at it just now, but once that money is stopped people will realise it may not be viable because of the additional costs.’

Medical defence bodies insisted that they did not uniformly apply ‘out-of-hours rates’ to extended hours work and considered each GPs’ case individually.

Dr Iain Barclay, head of medical risk and underwriting at the Medical Protection Society, said: ‘Membership subscriptions are set fairly to reflect the level of risk experienced by each area of practice. The subscription rate for GPs are each considered on their own merit and MPS does not apply “out-of-hours” rates to all GPs working “extended hours”.’

A spokesperson for the MDDUS said: ‘We are pleased to reassure our members that work undertaken in “extended hours”, where a GP is providing predominantly non-emergency care and has access to full patient records, will be treated the same as sessions undertaken within the normal working week for MDDUS subscription purposes.’

The spokesperson added: ‘We would assess the risk on a case-by-case basis and provide an individual subscription for the GP concerned.’

The Medical Defence Union issued the following statement: ‘We tailor our subscriptions to our individual member’s needs. If members have any queries about their subscriptions we would encourage them to contact us.’

Readers' comments (24)

Fascinating reasoning behind all this. One of the main reasons behind the setting of fees for Out of Hours work has been the inherent risk of not knowing the patient and not having full access to the records. Many of the 7 day week pilots are shared ones based on sharing of records and I guessing from this , the indemnifiers will not be putting OOH rates onto those doctors even though they may not be from the same practice. How is it then in areas where there is full sharing of records indemnifiers are classing that as out of hours work despite the 'inherent risk' being diminished through full access to patient records?

The problem is that GPs are now doing so many different types of work outside of standard day time hours that the boundaries between them are becoming increasingly blurred and of course we change roles frequently. This is really risky for GPs because if you get the details wrong, you could potentially find yourself without cover. The MDO system lacks transparency and looks dodgier by the minute. There is only one solution to this and that is for the government to provide crown indemnity for all GPs.

The traditional MDO's are exploiting the fact that you can't be on the Performers list without Indemnity. They are declining indemnity for GPs who had GMC issues, even after being cleared. The GMC may allow a GP back to practice but some of the MDOs never forgive. Indeed they are proving more ruthless than the regulators. The BMA has been aware of this for more than 3 years and nothing has been done. Very soon, it is the MDOs that will have a final say on a GP practicing or not and not the GMC. The GMC does forgive and allow GPs a second chance, some MDOs never forgive. We have read several such reports in the Pulse. What is the GPC doing about that?

soon it will be impossible for some GP's to work if they are paying over 40% tax, 30% pension, and 20% of their income in indemnity fees. The take home income will be not worth the risks involved with the job. This might be the final nail in the coffin for ooh care anyway. Bring on the noctors and physicians assistants to take this on their shoulders without doctor cover. good luck.

These are huge firms operating out of fancy offices. Make no mistake, clinical negligence is a large and exploitative industry which is using the MDO system as a front to pump money into its coffers. This needs investigating by the National Crime Agency.

This does not solely apply to GPs. A Nurse Practitioner has just had her renewal information for normal weekday working hours, and the amount has risen from just under £700 to just under £7000!

Obviously we are challenging this, but have had to begin a payment plan to enable the NP to continue to work in the Practice. Having five NPs in the Practice, this has huge cost implications and despite being a group scheme, there has been no discussion/information shared with the Practice. The MD organisation will only speak to the member.

The only person gaining in this NHS wipe out of of our GP population is lawyers.The patients according to Prof Brian Jarman and Michael Hands in BMJ2012;345:e2839 and BMJ2013;346f209 only suffer.The medical directors and other managers should be taken to task for hurting patient care.The GPs should be supported by the Government against NHS excesses.Most lawyers after their persecution cannot afford the lawyers or the journey and stay at HQ of GMC Manchester.I